The authors have not supplied their declaration of competing interest.

In unipolar depressed patients participating in trials on antidepressants, we investigated if illness characteristics at baseline could predict conversion to bipolar disorder.

A long-term register-based follow-up study of 290 unipolar depressed patients with a mean age of 50.8 years (SD = 11.9) participating in three randomized trials on antidepressants conducted in the period 1985–1994. The independent effects of explanatory variables were examined by applying Cox regression analyses.

The overall risk of conversion was 20.7%, with a mean follow-up time of 15.2 years per patient. The risk of conversion was associated with an increasing number of previous depressive episodes at baseline, [HR 1.18, 95% CI (1.10–1.26)]. No association with gender, age, age at first depressive episode, duration of baseline episode, subtype of depression or any of the investigated HAM-D subscales included was found.

The patients were followed-up through the Danish Psychiatric Central Research Register, which resulted in inherent limitations such as possible misclassification of outcome.

In a sample of middle-aged hospitalized unipolar depressed patients participating in trials on antidepressants, the risk of conversion was associated with the number of previous depressive episodes. Therefore, this study emphasizes that unipolar depressed patients experiencing a relatively high number of recurrences should be followed more closely, or at least be informed about the possible increased risk of conversion.

Hippocampal volume reductions in major depression have been frequently reported. However, evidence for functional abnormalities in the same region in depression has been less clear. We investigated hippocampal function in depression using functional magnetic resonance imaging (fMRI) and neuropsychological tasks tapping spatial memory function, with complementing measures of hippocampal volume and resting blood flow to aid interpretation.

A total of 20 patients with major depressive disorder (MDD) and a matched group of 20 healthy individuals participated. Participants underwent multimodal magnetic resonance imaging (MRI): fMRI during a spatial memory task, and structural MRI and resting blood flow measurements of the hippocampal region using arterial spin labelling. An offline battery of neuropsychological tests, including several measures of spatial memory, was also completed.

The fMRI analysis showed significant group differences in bilateral anterior regions of the hippocampus. While control participants showed task-dependent differences in blood oxygen level-dependent (BOLD) signal, depressed patients did not. No group differences were detected with regard to hippocampal volume or resting blood flow. Patients showed reduced performance in several offline neuropsychological measures. All group differences were independent of differences in hippocampal volume and hippocampal blood flow.

Functional abnormalities of the hippocampus can be observed in patients with MDD even when the volume and resting perfusion in the same region appear normal. This suggests that changes in hippocampal function can be observed independently of structural abnormalities of the hippocampus in depression.

Attentional impairment is a core cognitive feature of major depressive disorder (MDD) and bipolar disorder (BD). However, little is known of the characteristics of response time (RT) distributions from attentional tasks. This is crucial to furthering our understanding of the profile and extent of cognitive intra-individual variability (IIV) in mood disorders.

A computerized sustained attention task was administered to 138 healthy controls and 158 patients with a mood disorder: 86 euthymic BD, 33 depressed BD and 39 medication-free MDD patients. Measures of IIV, including individual standard deviation (iSD) and coefficient of variation (CoV), were derived for each participant. Ex-Gaussian (and Vincentile) analyses were used to characterize the RT distributions into three components: mu and sigma (mean and standard deviation of the Gaussian portion of the distribution) and tau (the ‘slow tail’ of the distribution).

Compared with healthy controls, iSD was increased significantly in all patient samples. Due to minimal changes in average RT, CoV was only increased significantly in BD depressed patients. Ex-Gaussian modelling indicated a significant increase in tau in euthymic BD [Cohen's d = 0.39, 95% confidence interval (CI) 0.09–0.69, p = 0.011], and both sigma (d = 0.57, 95% CI 0.07–1.05, p = 0.025) and tau (d = 1.14, 95% CI 0.60–1.64, p < 0.0001) in depressed BD. The mu parameter did not differ from controls.

Increased cognitive variability may be a core feature of mood disorders. This is the first demonstration of differences in attentional RT distribution parameters between MDD and BD, and BD depression and euthymia. These data highlight the utility of applying measures of IIV to characterize neurocognitive variability and the great potential for future application.

Health-beneficial effects of adhering to a healthy Nordic diet index have been suggested. However, it has not been examined to what extent the included dietary components are exclusively related to the Nordic countries or if they are part of other European diets as well, suggesting a broader preventive potential. The present study describes the intake of seven a priori defined healthy food items (apples/pears, berries, cabbages, dark bread, shellfish, fish and root vegetables) across ten countries participating in the European Prospective Investigation into Cancer and Nutrition (EPIC) and examines their consumption across Europe.

Cross-sectional study. A 24 h dietary recall was administered through a software program containing country-specific recipes. Sex-specific mean food intake was calculated for each centre/country, as well as percentage of overall food groups consumed as healthy Nordic food items. All analyses were weighted by day and season of data collection.

Multi-centre, European study.

Persons (n 36 970) aged 35–74 years, constituting a random sample of 519 978 EPIC participants.

The highest intakes of the included diet components were: cabbages and berries in Central Europe; apples/pears in Southern Europe; dark bread in Norway, Denmark and Greece; fish in Southern and Northern countries; shellfish in Spain; and root vegetables in Northern and Central Europe. Large inter-centre variation, however, existed in some countries.

Dark bread, root vegetables and fish are strongly related to a Nordic dietary tradition. Apples/pears, berries, cabbages, fish, shellfish and root vegetables are broadly consumed in Europe, and may thus be included in regional public health campaigns.

On 11 June 2009, an Influenza A (H1N1) pandemic was declared by the World Health Organization (WHO). The Major Medical Incident Regional Command and Control Protocol in the County Council of Östergötland, Sweden was activated. After vaccinations were competed, it was decided that the operation should be evaluated in a retrospective study. This study aims to increase knowledge regarding regional management of a pandemic flu.

All protocols from regional command meetings were studied together with central data regarding, logistics, vaccination site reports, incident reports, and all written correspondence between involved departments. Information from results of a questionnaire that was distributed to all vaccination site managers were summarized and studied. In addition, an interview was performed with the chief of medical operations.

Out of the approximately 426,000 inhabitants of the county, a total of 224,780 (53%) were vaccinated during a five and a half month period. The mean pace was 1,246 vaccinated per day (range 0–9643). Regional command had 41 recorded meetings resulting in a collected number of about 740 working hours. Three hundred sixty-six employees were involved in the vaccination, working 38,741 hours. Twenty-eight safety and 52 security incidents were reported. Uncertainty about vaccine delivery and keeping the public's interest were reported to be of concern for the management.

Even with the large scale of the operation, there were only a few security and safety issues. Although the goal of vaccinating 75–80% of the inhabitants was not reached, it could be assumed that the pandemic was dampened. Given the public's high initial interest, it could be considered that vaccination should not start until a large number of doses have been delivered.

The medical incident command structure and protocol successfully can be adapted to a mass vaccination event. Information from the Östergötland County Council operation yielded significant experience for future mass vaccinations.

Communication and information are cornerstones of management during major incidents and disasters. To support medical command and control, the Web-based support system called Paratus Major Incident can be used. The Paratus Major Incident system can provide management staff with online information from the incident area, and support management and patient handling at both single and mass-casualty incidents. The purpose of the Web-based information technology (IT) system is to ensure communication and information between the medical management at the scene, hospital management, and regional medical command and control (gold level).

In the region of Östergötland, Sweden, Paratus Major Incident system is used in operating topics such as: (1) information dissemination from the incident area; (2) communication between prehospital, regional, and hospital management; (3) continuous updates between the dispatch centre and medical commanders at all levels; (4) digital log-files for medical management and patient records; (4) database used for follow-up studies and quality control.

During 2,161 incidents, 746 “first incident reports” from ambulance on scene were sent to regional medical command and control within 2 minutes. Four hundred and fifty-six “verification reports” were sent within 10 minutes. During 15 incidents, the designated duty officer on regional level confirmed “major incident” directly via the digital system, thereby notifying all arriving ambulance resources and involved medical managements.

This Web-based IT system successfully has been used daily within prehospital management since 2005. The system includes medical command and control at the regional level and all involved hospitals in a major incident.